Risk Factors for Surgical Site Infection after Minor Dermatologic Surgery

Abstract

BACKGROUND Surgical site infection (SSI) after dermatologic surgery is associated with poor outcomes including increased recovery time, poor cosmesis, and repeat visits to doctors. Prophylactic antibiotics are prescribed to reduce these adverse outcomes. Identifying risk factors for SSI will facilitate judicious antibiotic prophylaxis. OBJECTIVE To identify risk factors for SSI after minor dermatologic surgery. METHODS Individual patient data from four large randomized controlled trials were combined to increase statistical power. A total of 3,819 adult patients requiring minor skin procedures at a single facility were recruited over a 10-year period. The main outcome measure was SSI. MAIN RESULTS A total of 298 infections occurred, resulting in an overall incidence of 7.8% (95% confidence interval [CI], 5.8–9.6), although the incidence varied across the four studies (P = .042). Significant risk factors identified were age (relative risk [RR], 1.01; 95% CI, 1.001–1.020; P = .008), excisions from the upper limbs (RR, 3.03; 95% CI, 1.76–5.22; P = .007) or lower limbs (RR, 3.99; 95% CI, 1.93–8.23; P = .009), and flap/two-layer procedures (RR, 3.23; 95% CI, 1.79–5.85; P = .008). Histology of the excised lesion was not a significant independent risk factor for infection. CONCLUSIONS This study demonstrated that patients who were older, underwent complex excisions, or had excisions on an extremity were at higher risk of developing an SSI. An awareness of such risk factors will guide evidence-based and targeted antibiotic prophylaxis.

Procedure-Related Risk Factors for Surgical Site Infection in Dermatologic Surgery

“…A recent study meta-analyzed data of 4 randomized controlled trials (RCTs). 9 The included trials assessed the impact of wound covering, different topical antiseptic agents, or the use of nonsterile gloves. In line with the study findings, the authors found that advanced techniques were associated with a higher SSI risk.…”

“…In the past, other articles narratively summarized the literature on risk factors of SSI in skin surgery. 8,9 In addition to systematically reviewing the current literature, the authors aimed to perform meta-analysis to statistically analyze the impact of potential risk factors. Given the amount of identified relevant data, the authors categorized risk factors into patientrelated, procedure-related, and body site-related.…”

Risk Factors for Infection After Minor Dermatologic Procedures: A Case–Control Study

“…5,7,9 The only statistically significant risk factor for infection in multivariable analysis was procedure location on the leg or arm; these sites were similarly identified as risk factors in a recent study of the infection rate after cutaneous excisions. 10 Further studies are warranted to determine whether alterations in perioperative protocols (technique and agent chosen for operative site preparation, topical agent applied to the site postoperatively, and utilization of postoperative compression on the legs) can improve the infection rate on the extremities.…”